Tony Blair: Along with my right hon. Friends the Chancellor of the Exchequer, the Secretary of State for Environment, Food and Rural Affairs and the Secretary of State for International Development, I met representatives of the Stop Climate Chaos coalition yesterday. We need to do three major things. First, we need to strengthen the international framework, both through the United Nations process and through the G8-plus 5 dialogue, which has been very useful indeed. Secondly, we need stronger action at European level, especially on the extension of the emissions trading system post-2012. Thirdly, obviously, we need action here. We are giving careful consideration to the idea of a carbon budget, which was advanced by the coalition yesterday. However, I think that this country has led the way over the past few years in respect of the environment and climate change, and we must continue to do so.

David Cameron: May I join the Prime Minister in expressing our sympathy for the families of the two British soldiers who died in Iraq yesterday? They died serving our country, and we should honour their memory. I also agree with what the Prime Minister said about Mr. Speaker, and wish him a speedy return.
	On a happier note, may I thank the Prime Minister for the flowers that he sent to my family? He may not know that I received flowers from both No. 10 and No. 11. I am delighted to be the first man in history to get bunched by both our Prime Ministers.
	Yesterday the Government published their Education and Inspections Bill. The phrase "trust schools", which appeared throughout the White Paper, has now disappeared. Can the Prime Minister confirm that he is renaming those schools "foundation schools," and that they will have all the same freedoms?

David Cameron: He will see me in the Lobbies. We back school freedom. That is 200 of us. If he can just find 150 of his own MPs, we can get on and pass the Bill.
	Two former Cabinet Ministers, the right hon. Members for North Tyneside (Mr. Byers) and for Darlington (Mr. Milburn), have said that the Prime Minister's position would be untenable if he relied on Conservative support. Does he agree that that is nonsense and that he should just get on and do the right thing for school standards and for our children?

Andrew Lansley: I beg to move,
	That this House supports the achievement of good oral health through the provision of NHS dentistry; calls, therefore, on the Government to fulfil its commitment that everyone should have access to NHS dentistry; is alarmed that the British Dental Association regards the new dental contract as 'a shambles' and is concerned that many dentists will reduce their commitment to NHS dentistry; and further calls on the Government to withdraw the National Health Service (General Dental Services Contracts) Regulations 2005 and the National Health Service (Personal Dental Service Agreements) Regulations 2005 and immediately to re-open negotiations with the dental profession on dental services contracts which are piloted and linked to patient registration and capitation payments, support for preventative work and the achievement of good oral health.
	In September 1999 the Prime Minister said that by 2001 everyone would have access to NHS dentistry just by calling NHS Direct. Six years after he made that pledge fewer people than ever are registered for NHS dentistry. In those six years we have seen queues forming outside the premises of NHS dentists who are opening up their registrations. We may not see that in future because the Government propose that people will not be able to queue outside NHS premises to be registered; they will have to register by letter or by telephone—queuing is too embarrassing. Indeed, the situation has now become so bad that the public are queuing outside private dentists.

Damian Green: My hon. Friend and the Minister might be interested in an e-mail that I received a few days ago from a constituent. It reads:
	"Since I moved to Ashford some 40 years ago I have attended the same dental practice. Last Tuesday, after my six-months check-up, I was advised that due to Government contract changes I would no be able to make a new appointment."
	That is what dentists believe and that is what their patients believe. Contract changes are driving people away from the NHS.

Rosie Winterton: Of course. [Laughter.]

Eric Martlew: Thank you for calling me, Mr. Deputy Speaker. Before I get into my speech, I should like to thank all the hard-working dentists in my constituency and throughout the country who work well with the NHS. Sometimes, in my local skirmishes with some of my dentists, I have perhaps forgotten that.
	Did not the hon. Member for Falmouth and Camborne (Julia Goldsworthy) think it odd that the dentist whom she mentioned treated only his family on the NHS? Did she not think that that was a bit of sharp practice? Perhaps I am na-ve. Perhaps she can put his name on the record so we can all know who it is.
	I have sat and watched the Opposition—the major Opposition, because there is no one here from Lloyd George's party. One of the Conservative Members who attended the debate was a Minister in the previous Government and a practising dentist. The right hon. Member for Wokingham (Mr. Redwood) has just left, but he was in the Cabinet when the Conservative Government closed two dental schools. It is no good Conservative Members putting up their hands up and saying that that was 10 years ago. They did it and they also cut fees by 7 per cent. So do not imagine that dentists, even though they are angry with us, believe the Conservatives. They remember what being a dentist was like under the Conservatives. The haemorrhage of dentists away from the NHS started during their time in office, whether by accident or design; I leave Members to figure out which it was for themselves.
	There was a severe problem in Carlisle when four dental practices decided to resign from the NHS. They resigned before they saw the contract, so that was not their reason for doing so. The hon. Member for South Cambridgeshire (Mr. Lansley) mentioned people queuing to sign up for private treatment, and that did indeed happen at a particular practice in my constituency. The dentist in charge of it sent out a letter saying, "If you don't queue up and sign up, bringing your bank details with you, you won't be able to get a place." That resulted in hundreds of my constituents queuing from 5.30 in the morning, waiting to sign up. [Interruption.] If the hon. Member for South Cambridgeshire will contain himself, I will get to the point. That dentist was even handing out raffle tickets in another part of Cumbria. He said that he was going to cut the list, and that those who did not sign up early would be unable to get on it.
	A lady came to my constituency office on Friday and told me that she phoned that dentist four months later. The receptionist was over the moon that someone had actually phoned to ask whether they could sign up. In fact, the dentist had plenty of places left. Some dentists who have gone private will have a problem when—

Geoffrey Cox: Does the hon. Gentleman not agree that, if a charge of £183 is levied for a single crown and precisely the same charge is levied for doing six crowns, the incentive for those whose teeth are becoming bad will be to wait until they are sufficiently bad to maximise the value for money that they get from the charge that they pay?

David Burrowes: It is a pleasure to follow my hon. Friend the Member for North-East Milton Keynes (Mr. Lancaster), who gave us several examples of problems in his constituency that are reflected in mine. The Government's proposals on NHS dentistry are characterised by being target driven, centralised and shambolic, although perhaps we should not be surprised because that is a description of their general approach to the NHS. Several Labour Members focused their comments on the relatively high salaries of dentists, but it should be noted that Conservative Members are worried about access for patients, which should be the focus of the Government.
	I want to talk especially about younger dentists because the proposals have been presented as representing a bright future for NHS dentistry. However, is that the case? I suggest that they are yet another nail in the coffin for NHS dentists, especially young dentists. I concede that funding, recruitment and the number of training places have increased, which is welcome. However, how will that affect in practice young dentists who want to be part of the supposed bright future? Will my constituents get proper access to a dentist? I suggest that the contract is an obstacle to any of the relatively good progress that has been made and a road block for young dentists.
	Let us consider the situation for young women dentists, especially those who are young mothers. One of my constituents, Mrs. Surabaskaran, has told me about her experiences, which are no doubt replicated throughout the country. She is an NHS dentist who graduated in dentistry in 1998 from Kings college school of medicine and dentistry and looked forward to a future in the NHS. She was on maternity leave for five months during the relevant period over which her contract value was calculated, and has been in negotiation with the PCT to get an appropriate contract value. However, her maternity leave has been wholly discounted, so she has effectively been left with a contract that would be worth half her salary. Although she has 2,000 patients on her list, there is a risk that she will be forced out of the NHS because the PCT has stonewalled by saying that it has insufficient funds to address the situation.
	The Minister might well point out that the framework proposals said:
	"Allowances will be made where the practice has carried a vacancy"—
	for example, due to maternity leave. It was suggested that allowances could be made for dentists who were
	"increasing or reducing, or planning to increase or reduce the amount of NHS care they provide"
	during the relevant period. However, despite all the good intentions in "Framework proposals for primary dental services in England in 2005", the reality is that a young dentist such as Mrs. Surabaskaran is being left short when negotiating her contract because the local PCT refuses to award a contract with the value that she should properly have.
	As the PCT has said no to Mrs. Surabaskaran, she must use the dispute resolution procedure for the contract and go to the Secretary of State. However, where will that leave her? Will she be guaranteed a better value than that which she has been offered? Given that the contract should have been signed yesterday, she faces the precarious predicament of endangering not only her future career in the NHS, but the 2,000 patients who are on her list. Is the process for dispute resolution appropriate? Should the Secretary of State be the binding determinant of a contract? Such a procedure might be appropriate in different parts of the NHS, but should the Secretary of State make decisions about a party who is a sub-contractor risking private capital? Again, the controlling hand—the dead hand—of the Government is at the heart of the proposals. We have heard that D-day has passed, so many NHS dentists, especially young dentists, face chaos.

David Burrowes: I am grateful to the Minister for that point, but my constituent has no guarantee that she will receive her due reward. She runs the risk of being given a contract with a value that is half what it should be. Neither she, nor any other NHS dentist, has an individual contract guarantee.
	We must also consider the situation facing graduates. We have to welcome the fact that 100 extra dental school places were announced on 26 January, but is that the only way to secure the future of NHS dentistry? The Dental Practitioners Association says:
	"The current NHS access problem"—
	the concern is not so much about salaries or training places, but NHS access—
	"is caused by the large gap between the terms and conditions offered by the NHS and those in the private sector. This has led to an outflow of dentists from the NHS which has been exacerbated by the prospect of an inflexible and inefficient new NHS contract in April 2006 which is generally expected to make working in the NHS less desirable to most dentists."
	That is the case, particularly for vocational dental practitioners. How do they fare with this contract? If one looks at the detail of the contract, one sees that all revenue associated with vocational training will be put on hold during the relevant period and will be removed from the contract value. The employment of vocational dental practitioners will essentially be at the behest of the primary care trust. We have heard already of deficits among PCTs, and the situation is the same in my constituency. It is fair to suggest that the first to feel the squeeze in the PCTs' capacity to deliver NHS dentistry will be vocational dental practitioners, who will be unable to find a place to pursue their training. Many a dental practice is not receiving, in its units of dental activity, any recognition of vocational dental practice. The PCTs do not have to provide that recognition. They have been asked by the Government to do so, but there is no specific requirement to take any account of the vocational route that we would wish many people to follow.
	Finally, I turn to the care given to patients. It is at the heart of the motion, which refers to support for preventive work and the achievement of good oral health. The Minister says that, yes, it is all about preventive care, but what is the reality? As dentists in my constituency tell me, no real value is given to preventive treatment in the UDA system. Root canal treatment is worth three points, as is extraction. Root canal treatment usually takes three 45-minute visits, while extraction takes half an hour, so there will be an incentive to take out a tooth rather than give root canal treatment, despite their having the same UDA value of three points. Dental repairs too, will come straight out of the dentist's salary, so there will be an incentive to fit fewer crowns and more fillings. The contract looks more to points than to patients.
	I should conclude because I have gone way over the time—8 minutes—that dental practitioners will be allowed by the contract for an examination, X-ray, and scale and polish. The question is not so much whether there will be time for NHS dentists to give quality care but whether there will be any access at all to NHS dentists.

Paul Rowen: I agree entirely. The situation in the borough of Rochdale will get worse because dentists in the Heywood and Middleton constituency—I think that there are eight—have said that they, too, have no intention of signing the new contract. A borough that already has a very poor record of dental health will be left with virtually no NHS dentists. Yes, we have a walk-in centre, and it is fully committed, but it is doing nothing in the way of preventive work. It simply cannot cope with that on top of the emergencies that it deals with.
	In the past 12 months we have seen new dental practices open in neighbouring areas, such as Radcliffe and Bury. People in my constituency have queued from 5 o'clock in the morning to get themselves on the list at those practices. A dentist from Zimbabwe recently opened a practice in the neighbouring constituency of Oldham, East and Saddleworth, and within four days his list was full. Rochdale needs 10 dentists to treat those people who cannot afford to go to a private dentist.
	When the Balderstone surgery announced that it was pulling out of the NHS, a constituent came to see me. He said that he had been told bluntly that if he wanted to stay with the practice he had to be prepared to pay £15 a month. There is no way that that gentleman could afford that sort of money. I wrote to the PCT, pointing out the situation with the last remaining NHS practice and asking what it was going to do and what advice it could give me to pass on to my constituent. The advice was laughable; it was to look at the website. When one looks at the website—not everyone has access to the web—one asks, "Where are the dentists for Rochdale?" They simply do not exist. I really am sick of hearing talk about this new contract and what it is supposed to deliver, when the few dentists left in the NHS are being driven out as a result of the obsession with targets.
	We need to hear concrete proposals from the Government to address real shortages. I have been asking since May, when I was elected, what the Minister will do to deal with the crisis in my constituency. Everything that she has done so far has made the situation worse. In the next few years we will see a dramatic rise in dental ill-health; we will see more expensive treatment having to be carried out; and we will see people's general dental health deteriorating greatly. That is not why the NHS was created. It is not what the Prime Minister promised us back in 1999, when he said that everyone who wanted an NHS dentist would have one within two years. The reality is that fewer and fewer people in my constituency have access to a dentist.
	I have asked for a meeting with the Minister. I invite her to come to Rochdale and explain to people why we cannot get NHS dentists in the constituency. They deserve answers and we ought to have them now.

Mark Pritchard: I applaud the Minister's courage on coming to the Chamber for the debate, given that there is opposition on all Benches, including the Labour Benches, and opposition outside the House to the Government's proposals.
	I praise the work of dentists throughout Shropshire, especially in my constituency. I praise also the professionals who work in orthodontics and dentistry at the Princess Royal hospital in my constituency. They all provide a valuable and vital health service for my constituents.
	I note that the Government have tried to shift the blame from them to primary care trusts and to dentists. However, it is the Government who will be funding PCTs. Those trusts, with scarce resources, will have to apportion dental contracts accordingly. Given that Shropshire County PCT and Telford and Wrekin PCT are already struggling financially, that does not hold out much hope for my constituents with dental problems for the months ahead. That is clearly of concern to them and to me.
	I remind the Minister of the Prime Minister's comments at Question Time today—that we should trust professionals. We have heard that mantra over many months. We were told in the context of the Terrorism Bill that we must trust the professionals. We were told, "The police are asking for X and we should give them X." Why is it that on this issue the Government are not prepared to listen to the professionals? Let us listen to the words of the British Dental Association. It says:
	"The Government's aims of securing patient access, improving oral health and raising the quality of patient care will not be achieved by the imposition of this target-driven NHS contract."
	If the Government are serious about listening to professionals, let us see them listen to dental professionals on this point.

Mark Pritchard: I am tempted to go down that route. I know that Labour Members do not want us to address serious issues on dental care. That being so, I shall stick to the substantive points that other Members have raised. I shall be happy to discuss the point that the hon. Gentleman has raised outside the Chamber at a later stage, at his cost, over a cup of tea.
	It has been said that it is the poor who will suffer, and that is absolutely right; and that the elderly will suffer as a result of the proposed changes, and that is absolutely right. In addition, every-day families and single people—in fact, everybody—are likely to suffer in the light of the proposed changes.
	The Minister has reminded us of the number of dentists entering or opting in to NHS contracts. The overall net figure, including those who have opted out of NHS contracts over the past few months, or who are likely to do so, shows that there will be a drain away from the NHS. There will be fewer dentists providing NHS treatment. I accept that some centres have opened, and I know that in the neighbouring constituency to mine—Telford—there will be a new centre, but that will not meet the needs of all the constituents in Shropshire. The demand will not be met. Unfortunately, there is a net loss overall.

Mark Pritchard: Absolutely; crisis is an appropriate word. We have a crisis in health care generally, and it is not the fault of the professionals who are working in our hospitals, our dental practices and our primary care sector. On so many of these issues, the fault lies with the Government. We have seen today Ministers smiling and taking these issues lightly, no doubt with extremely health teeth. They should take these issues far more seriously and look after my constituents who are unable to access NHS dentists.
	The Minister might be aware—I have discussed this previously with her—that the nearest dentist for some of my constituents in, for example, the wonderful market town of Shifnal, is as far away as Litchfield. It is totally unacceptable that young mothers, often having to use public transport, have to change two or three times to access the NHS. As my hon. Friend the Member for North-East Milton Keynes (Mr. Lancaster) rightly said, given that people have paid their taxes, the very least that they might expect is the standard of NHS dental care that they enjoyed over many years. There has been criticism of past Conservative Governments, but at least people could register under the previous Conservative Government with an NHS dentist. People will not be able to do so given the present proposals.

Andrew Murrison: We have had an instructive debate this afternoon, with a total of 11 Back-Bench speeches, all of high quality. I have received reams of correspondence from dentists about the new contract—none of it is complimentary. Ministers will be particularly interested in messages I have received from Leicester, Doncaster, Liverpool and Birmingham. Most of them use parliamentary language, but some do not. I should like to begin by sharing one that I have just received from Doncaster, as I know that the hon. Member for Doncaster, Central (Ms Winterton) will be interested in it:
	"As of 1020 hours Doncaster time, we have not received a contract . . . I can state with a fair degree of confidence 100 per cent. of dentists in Doncaster have not agreed to the new contract."
	The Minister made great play of apparent demands from patients for a simplified, more transparent charging mechanism, but I can honestly say that I have not met a single constituent who is exercised about the complexities of the charging system. However, like my hon. Friends the Members for Totnes (Mr. Steen), for North-East Milton Keynes (Mr. Lancaster) and for The Wrekin (Mark Pritchard), as well as the hon. Member for Rochdale (Paul Rowen), I have received shedloads of letters about deteriorating access to NHS dentistry. That is not surprising, because in the strategic health authority area serving my constituents only 25 per cent. of people are registered with an NHS dentist. I am horrified to hear that in the constituency of my hon. Friend the Member for Preseli Pembrokeshire (Mr. Crabb) the figure is even lower at 15 per cent.
	As constituency MPs we know—and Citizens Advice recently confirmed it—that access to NHS dentistry is of overwhelming concern to dental patients, despite the Prime Minister's famous pledge in 1991, which, I note, is not reiterated in the Government amendment to our motion. The contract is set to make matters much worse. Community Dental Centres is a group of nine major dental practices in the west country that cares for 100,000 patients. It announced yesterday that unless there are changes to the contract it is likely to pull out of NHS dentistry. It points out, as did the London local dental committees that I met last night with the hon. Member for Hayes and Harlington (John McDonnell) and my hon. Friend the Member for Ruislip-Northwood (Mr. Hurd), that payments will be based on dental activity, which is not the same as dental care. Activity implies the treadmill, which is precisely what we thought Ministers were keen to remove. Dentists want to offer care to patients, not activity, and the Minister ought to know the difference between the two.
	The consumer organisation, Which?, and the National Audit Office appear united in their belief that primary care trusts are simply not up to managing the new contract. Which? has asked for a clear audit framework to measure the impact of the changes. That would at least allow us to draw breath and reconsider after a few months or a year. I am pleased to hear that the Minister is going to put in place a review group and implementation team. I hope that it meets in six months' time and in 12 months' time and that at each of those points, as the hon. Member for Hayes and Harlington suggested, there is a report that is debated in this place.
	What is the Minister doing about contractual arrangements for practices that have grown in the test year? Yesterday, I met a full-time NHS dentist from south-west London who is preparing to sack three members of staff on 1 April because his practice growth has outstripped his allocation of units of dental activity. That problem, which was well described by my hon. Friend the Member for Enfield, Southgate (Mr. Burrowes), is particularly severe for young orthodontic practices, because they are paid eighteen months in arrears. An orthodontist from Bristol wrote to the Minister, with a helpful copy to me, to say:
	"The financial disaster we are facing is due to the methodology adopted by the Department of Health for deriving contract values for orthodontic practices."
	On the same theme, a Birmingham dentist writes:
	"One Dentist in South Birmingham extended his practice to 6 Dentists last year from 3 to accommodate the extra patients seeking NHS treatment, he has been told his budget is such that the 6 dentists must work part time or 3 must leave, as his funding is based on the period when he had 3 dentists. This will leave about 4000 patients without a Dentist."
	Clearly, at this late stage there is considerable confusion about how the anomalies that the test year will introduce are to be resolved. This is the eleventh hour.
	I am assuming that moneys released from the many dentists who opt out will be reallocated to the few who are expanding their services or to the Government's massively expensive dental access centres. However, practices willing to expand have not been told that that is the case. Can the Minister offer us a time scale? Why are we getting reports that the few high street dentists still willing to take NHS patients are being turned down if there is a dental access centre nearby, despite the big cost disparity? I suspect that it is because dental access centres are a Government pet project that must be supported at all costs.
	More concerns emerge from Birmingham on the subject of out-of-hours cover. It appears that the contract, taken with PCT deficits, will mean that post-1 April cover will be basic, to say the least. Birmingham dentists have been told that haemorrhage and swelling that compromises the airway are the only items to be regarded as dental emergencies, which means that dental pain is not. Dental pain is the most common form of dental emergency, and for those of us who have suffered it in the middle of the night it truly is an emergency. Are we really to have a contract that will allow people in this country, in the 21st century, to struggle through the night with acute dental pain?
	I have had a raft of messages from dentists over the past six weeks or so. I will read just a few of them. They would fill two box files and, sadly, time does not permit me to read them all. A dentist from Coventry writes to me with more than a hint of desperation:
	"Three of my best friends with over 80 years of NHS experience between them have sent out their conversion letters."
	That is, conversion to private practice. He continues:
	"These are dentists who have stuck with the system until now. There are many hanging on there by their finger tips hoping this disaster will be stopped on Wednesday. They are torn because of feeling for their patients."
	He signs off,
	"Best of luck on Wednesday."
	A dentist from Yorkshire says, typically more briefly:
	"if these reforms come in I doubt there will be an NHS dental service worthy of the name in 3 years."
	A general dental practitioner from Colchester writes:
	"We will reduce our NHS commitment. Accordingly, letters will go out to my NHS kids/exempts shortly, and my associate will keep what little NHS funding remains, prior to a move to private practice within 12 months. It's the only solution that I can come up with that allows me to keep people in a job. The alternative is to make everybody redundant!"
	That raises an important point because, in Committee, the Minister said that primary care trusts could provide children-only contracts. However, since children and exempt adults do not pay the 80 per cent. contribution, how will PCTs that operate with massive deficits manage to provide such targeted contracts? The contracts that they let will depend heavily on the 80 per cent. co-payment.
	The contract is clearly too rigid. The British Dental Association rightly believes that dentists will overdo their UDAs for safety, yet there is no way to claim for them. If they undershoot, they will face penalties. Despite the assurances in Committee, the contracts that have emerged appear to allow for the tailing off of services towards the end of a year and for some jockeying to approximate as closely as possible the target number of UDAs. There is a parallel in the way in which PCTs finesse hospital treatment when funds run out at the end of the financial year. That is no way to manage patients.
	Ministers claim that the new contract will encourage a more preventive, health-promotion focus. How will that happen when the cost of the band 1 episode on which Ministers rely for health promotion will be at least twice the current cost? Nothing in the contract rewards the use of dental hygienists, whose services may become the preserve of private patients. I am sure that that was not the Minister's intention last year when she opened the school for complementary professions to dentistry in Portsmouth, which I had the pleasure of visiting last week.
	Several dentists have written about the perversities that the Government's interpretation of the Cayton report introduced. Earlier, we heard the Minister's explanation of the difference between the Cayton report and what we are now offered, and the extraordinary 40 per cent. uplift. Perhaps the Under-Secretary will expand on precisely what the Minister meant in her justification of the difference.
	We know that the cost of a basic filling will increase substantially and that a mouthful of fillings will cost the same as one. Clearly, the articulate and well-briefed patient will be able to obtain several items at once from band 2 while those who are less adept at using the system may lose out. There will be a tendency for dentists to offer simpler and quicker treatments in band 2 and only the guileful patient will be capable of pushing for more. Inevitably, that will widen oral health inequalities.
	Doubtless the Government will continue to blame previous Governments, local health care managers and practically anyone else they can think of for the chaos over which they preside. An insightful dentist wrote to me earlier this year. He said:
	"I believe you are after information about how the government are making a complete shambles of this new NHS dental contract."
	That is quite right. The writer continues:
	"What tickles me is, after 7 years, they are still trying to blame the previous Tory government. That's a bit like blaming potholes in the roads on the Romans."
	The hon. Member for Carlisle (Mr. Martlew) might like to note that point.

Liam Byrne: I need to respond to many valuable points, so I will not give way at the moment. If I have time nearer 4 o'clock, I will of course give way then.
	None of the increases that I mentioned has happened by accident. They have occurred because investment in NHS dentistry has risen substantially over the past few years. Indeed, it has gone up by 20 per cent., or £250 million, in the past couple of years. The Government have also recognised, however, that there are parts of the country in which an enormous amount more needs to be done. We therefore commissioned a report into the viability of the future work force, which in turn prompted our announcement of unprecedented investment.
	We have heard today that there is still an enormous amount to do, and the Minister of State set out a programme of reform that rests on three foundations. The first involves a new role for local health professionals working in primary care trusts to take a lead in commissioning services, and new arrangements to ensure that, when dentists leave the NHS, the money is recycled back into the NHS. From April this year, those health professionals will have the freedom to run budgets of about £1.7 billion. The second involves the big increase in the number of dentists being trained and recruited. The third is that we are seeking to change the relationship between the NHS and dentists with a new contract that will end the treadmill and encourage prevention. It will also encourage more dentists up and down the country to serve the NHS.
	The hon. Member for Mole Valley (Sir Paul Beresford) spoke with great insight and intelligence, as he always does on these matters, and I welcome his congratulations on some of the proposals that my hon. Friend set out. He said that the present system was not a treadmill. That was the opinion of one of his friends, but I think that the hon. Gentleman secretly believes that it is a treadmill. We must ask ourselves whether it is unreasonable for the NHS to agree to a certain amount of activity in return for writing cheques for £80,000 a year. Looking at the national picture, we shall be writing cheques for £2.3 billion worth of dental services, and it is not unreasonable to ask for a few specifics in return.
	The hon. Gentleman asked a number of important questions about whether there would be monthly targets and whether the PCT would be breathing down his friend's neck. There will not be monthly targets, and it is important to remember that the contract has been set in such a way as to ensure that dentists undertake 5 per cent. less work. It therefore represents a decisive move against the treadmill. We would, however, like to know the name of the hon. Gentleman's socialist dentist friend. Given what is happening, it will be important to ensure that his party membership is being paid by direct debit.
	The hon. Gentleman underlined the importance of the monitoring group that my hon. Friend the Minister of State announced, and I welcome his congratulations on that move. More broadly, NHS dentists, no matter who is in their chair, have to offer what is clinically necessary.
	The hon. Member for Totnes (Mr. Steen), who is not in his place, is an excellent advert for the hon. Member for Mole Valley. The hon. Member for Totnes did not say whether the treatment he received from his colleague was on the NHS, but in a thoroughly reasonable speech he highlighted concerns that underline the need for the reforms we are making—more investment, more recruitment and putting more people in training.
	The hon. Gentleman called for free care, but NHS care has not been completely free for some years, not even in Devon. The important point for him to pick up in Hansard is that the budget for NHS services next year will be ring-fenced. I think his PCT is Torbay, where there is a ring-fenced budget of £6.3 million for commissioning dental services next year.
	The hon. Member for North-East Milton Keynes (Mr. Lancaster) underlined the need for more dentists, which is an argument on which we would agree, but he should do more to challenge dentists locally who are refusing to register children. He questioned the number who might sign up to their contract by the end of the month. We shall see, as my hon. Friend the Minister of State said.
	We expect the vast majority of dentists to sign the new contract, and the point I would make to the hon. Gentleman about contract length is that contracts are a two-way deal. Many dentists do not want a contract of more than three years. Of course, the new general dental services contracts are an open-ended commitment, but the work that local health professionals will be doing in his area will be made substantially easier by the £8.2 million they will have to commission dental services next year.
	My hon. Friend the Minister of State was able helpfully to highlight a number of aspects of the contract, in particular the issue of the abnormal reference year, which was referred to by the hon. Member for Enfield, Southgate (Mr. Burrowes). He mentioned the example of a dentist who had taken maternity leave. She must take up the dispute resolution procedure with her PCT; it is important that she do so.
	I hope the hon. Gentleman accepts that it is not possible for my hon. Friend, formidable though she is, to negotiate every single contract personally. That is why she has to set a framework and rely to some extent on local professionals to operate within it. I should also say, if it is helpful to the hon. Gentleman, that my hon. Friend can sign and earmark the disputed clauses for later resolution.
	The hon. Member for The Wrekin (Mark Pritchard) made a number of points about listening to professionals. That is an important aspect that was highlighted in a document published yesterday, to which I shall refer in a moment, but, far from dentists not being listened to, the new system is virtually identical to that developed with the BDA two years ago. Far from blaming PCTs, we are putting more power in the hands of local professionals to negotiate local arrangements. What is more, they are doing a good job.
	In the hon. Gentleman's area, my hon. Friend tells me, there are new dentists arriving. He mentioned the centre that is opening just across the constituency border, where about 40,000 registrations will be available. That is part, I am glad to say, of a national pattern, and about 1,100 new dentists were recruited between April 2004 and April 2005.
	The hon. Gentleman made an interesting point. If I might be permitted a detour through the registration statistics under the last Conservative Government, he said that he is proud of that record, but I remind him that in the last four years under that Government registrations fell by 2.1 million.
	The hon. Member for Rochdale (Paul Rowen) highlighted the shortage of local dentists in his constituency—an issue that I think has been acknowledged. He made a number of points about the contract, the number of dentists in training and PCT responsibilities, all of which are incredibly important in taking things forward in his constituency. Rochdale's PCT has not one, but 20, NHS contracts and £4.3 million to commission services next year. He also criticised targets, but when we are writing cheques to a dentist for £80,000 it is not unreasonable to ask for a few things in return.
	My hon. Friend the Member for Carlisle (Mr. Martlew) spoke with great experience of health services. Usefully, he reminded us about our inheritance. He also reminded us helpfully of the struggles of living on £80,000. I extend my congratulations to his PCT, which is doing a good job locally. The fact that he has eight new dentists and 20,000 new registrations locally shows that progress is beginning to be seen in many parts of the country.
	My hon. Friend the Member for North-East Derbyshire (Natascha Engel) echoed the point about the need for reform and the lack of constructive criticism this afternoon. She was right to highlight the problems of shopping with toddlers, especially as one gets closer to the checkout. I have three children under the age of five, and I find that the only secure way of getting through a checkout is to put them in the trolley, where their little hands cannot reach through the bars. She made the important point that the reforms that we have introduced dovetail with a broader public health strategy.
	My hon. Friend the Member for Hayes and Harlington (John McDonnell), who, I am glad to see, has returned to his place, raised a number of important issues in an intelligent and thought-provoking speech. Where PCTs are wrestling with important issues, it will be of some comfort to know that money is ring-fenced for dentistry. He also raised the issue of the abnormal reference year. His PCT has the flexibility to discuss that in review with local dentists. As my hon. Friend the Minister of State said in reply to some interventions, dentists can sign contracts but mark disputed terms, which can be resolved later in dispute resolution. He was right to underline the importance of the implementation group—

Liam Byrne: I will pass that request on to my hon. Friend the Minister of State, and I am sure that she would be delighted to meet London dentists.
	The hon. Member for Falmouth and Camborne (Julia Goldsworthy) made a number of useful criticisms, although we did not hear much in the way of substance or constructive alternatives. I know that the ballot for the leadership of her party is taking place shortly, and I put on record my best wishes toall those candidates who remain in the field. I hope that whoever triumphs—if that is the word I am looking for—moves rapidly to fill in the blank sheet that he has been bequeathed.
	I suppose that I was looking for a slightly more forensic analysis from the hon. Lady. I know from the Electoral Commission's quarterly returns that the largest single donor to the Liberal Democrats in one quarter of last year was a company called Alpha Healthcare, so no doubt any future leader will be able to draw on a body of valuable expertise. She mentioned Birmingham, which I must mention as it is my home town. I got in touch with the Birmingham Mail yesterday, and in my experience it is right about most things. In the survey that it conducted of 175 dentists, between three and five dentists had definitively rejected the new contract—about 3.5 per cent. according to my maths. I look forward to progress over the rest of the month.
	The hon. Lady also spoke about dentists being insufficiently remunerated. Again, I do not think that £80,000 is bad.

John Baron: I beg to move,
	That this House recognises that there have been improvements in the provision of cancer care due to the extra investment in the NHS and the hard work and dedication of NHS staff; but notes that a different approach is now needed to raise standards of treatment throughout the entire patient pathway to the best levels achieved in other European countries; believes that more should be done to end the postcode lottery in drugs and treatments; wishes to see more done to raise awareness of the risk factors and symptoms of cancer; further believes that cancer is increasingly a long-term condition and that there should now be a greater recognition of the importance of quality of life issues; and calls on the Government to give the National Institute of Health and Clinical Excellence a much stronger role in establishing holistic standards and entitlements to care covering the entire patient pathway.
	No one can doubt the significance of cancer to many millions of people in this country. The disease remains one of the biggest killers in the UK, accounting for approximately a quarter of all deaths and claiming more than 150,000 lives a year. More than one person in three will be diagnosed with cancer at some point in their lives, and there is likely to be a significant increase in the number of new cases over the next few years, partly due to our ageing population structure.
	Given its importance, I hope that this debate about the future of cancer services can be constructive. I, for one, recognise that improvements have taken place under this Government, but I shall also highlight the fact that there are still failings in the system, in the hope that they will be recognised and put right.
	The Government's amendment runs the risk of appearing somewhat complacent. It is full of self-congratulation, and mainly looks back at the past. Putting that to one side, however, I accept that it would be churlish not to accept that the Government have made extra funding available and that improvements have been made. It is not often that a shadow Minister quotes good figures on the Government's behalf, but one example of those improvements is that, whereas only 42 per cent. of patients diagnosed with colon cancer in the first half of the 1990s survived for five years, that figure had risen to 50 per cent. by the start of the present decade.
	Naturally, Opposition Members congratulate staff in the NHS and the voluntary sector on their hard work and dedication to patient care, which have helped to bring about the improvements in outcomes. Those improvements are welcome, but they are not exceptional when compared to the long-term trends that date back to the 1980s.

Iris Robinson: My mother was diagnosed with breast cancer and had a mastectomy, and I had quite a scare last September. Does the hon. Gentleman agree that the Government must take steps to ensure the correct analysis of mammograms? Radiographers have got that wrong in the past, but patients need to be assured that they receive the correct results. Does he also agree that Herceptin should be given to the women who need it, and that we should not have a postcode lottery?

Sadiq Khan: The hon. Gentleman compared the UK to European countries with better success rates, but will he agree that we have seen improvements over the past eight years? In 1997, Labour was the first major political party to mention the word "cancer" in a manifesto. In 1997, we had a Green Paper that set a target on death rates for 13 years' time and, in 1999, for the first time, a directorate was set up to deal with cancer. Again for the first time, in 2000, we had a 10-year plan to fight cancer. Is it not the decades of neglect that have led to the problems that the hon. Gentleman mentions?

Andrew Turner: Does my hon. Friend accept that an important component of radiotherapy is being able to access the service? It is recognised by authorities that stress and concern about travel arrangements affects people's ability to benefit from radiotherapy. Will he congratulate the Isle of Wight council on announcing that it was making £50,000 available from its budget this year to fill the shortfall caused by the NHS withdrawing funding for radiotherapy patients to cross the Solent for treatment in Southampton?

Mr. Deputy Speaker: Order. I am sorry to interrupt the hon. Gentleman, but when he turns away to address his hon. Friend, he should bear in mind that should be addressing the Chair and that it is also important that he should address the microphones, otherwise, it creates a problem for Hansard.

John Baron: I appreciate that guidance, Mr. Deputy Speaker.
	The short answer is that I agree, but I shall make some progress.
	Let me turn to access to drugs—another area where cancer services should be doing much better. We have the best cancer research record in Europe but among the poorest uptake of new drugs, as recently confirmed by the Karolinska report, which identified that the UK was consistently below average in adopting new drugs for the treatment of breast cancer, colorectal cancer and lung cancer. The reasons for that are varied. First, the NICE process has been too slow. Delays have meant that English patients have been forced to wait for approval, even though patients in Scotland and the rest of Europe have sometimes received their drugs more quickly.
	Last year, CancerBACUP identified 23 cancer drugs that were subject to delays after NICE's budget was cut and the number of appraisal committees was reduced from three to two. Since then, some reform has taken place, and we support it. However, the success of the new single technology appraisal should not be won at the cost of other drugs going through the standard procedure more slowly. Ultimately, if NICE is to meet the growing demand for new drugs, it should be provided with the resources that it needs to support three appraisal committees.
	Another problem is that, although NICE was set up to tackle the postcode lottery in drugs throughout the country, its guidelines are subject to postcode lotteries—a fact recognised by the cancer tsar, Mike Richards, in his report two years ago. More recently, the Public Accounts Committee report confirmed that, one year after NICE approval, the use of Herceptin for breast cancer ranged across cancer networks from 90 per cent. to under 10 per cent. of eligible women.
	For one bowel cancer medicine—Eloxatin—independent research found that more than one in four consultant oncologists were not able to implement new NICE guidance in the 90-day implementation period. Those clinicians cited the lack of funding as the main reason, despite the Government's extra investment in the NHS. Such regional variations must end.
	The Opposition believe that we have a system that is essentially unfair. There is an inherent inequity in the system in gaining access to drugs. The postcode lottery for the availability of drugs can only be eradicated if NICE is asked to carry out full resource implementation assessments alongside its appraisals for cost and clinical effectiveness. That will help to ensure that aspirations contained in the guidance become a practical reality. The guidance will be realistic because the decisions have been costed.
	Nowhere has the controversy over access to drugs been fiercer than over the funding of Herceptin for early-stage breast cancers. The intervention by the Secretary of State for Health last October, when she suggested that PCTs should not withhold the drug for reasons of cost alone, has added to confusion about patient entitlement to unlicensed drugs. Inadvertently, the right hon. Lady raised the hopes and expectations of women with HER2 positive breast cancer that they would have access to that drug, but those hopes were crushed by the High Court ruling last month. If her original remarks at the Breakthrough Breast Cancer fly-in did not sufficiently create the impression that eligible women should expect primary care trusts to fund Herceptin where a clinician was prepared to prescribe it, her subsequent decision to challenge North Stoke PCT certainly did. Now, there is still a postcode lottery in the prescribing of Herceptin for early-stage breast cancer, as PCTs come to different decisions about the drug. That was the danger in the Secretary of State pre-empting NICE.

Howard Stoate: It is impossible for NICE to make a decision on early-stage breast cancer because, as the hon. Gentleman knows, Roche only applied for a licence for Herceptin in the past few days. Is he as dismayed as I am that Roche has been so slow in pushing for a licence for a drug that American studies have shown to be so useful?

John Baron: The key question is: on what basis should Herceptin be available now? The Secretary of State has caused confusion by intervening and overruling NICE. Primary care trusts are in a very difficult position. Some, like Swindon, will have the option of not funding Herceptin if they can demonstrate doubts about its safety or clinical effectiveness. However, the PCTs that have decided to fund Herceptin for early-stage breast cancer on the back of the right hon. Lady's intervention find themselves in a difficult situation. Although many trusts are struggling with deficits, the Secretary of State has not made special funding available. Local health managers face the unwelcome task of diverting funding away from other services, including those for other cancer patients, to action a political instruction from Government half way through the financial year.
	It is no surprise that Pamela Goldberg, the chief executive of Breast Cancer Campaign, has said—I hope the House will forgive me for citing her comments, but they provide a powerful illustration of the situation—that the intervention
	"has caused more anxiety and confusion than clarifying the situation. Unless financial resources follow this sort of intervention we will see a situation where patients will be forced to challenge decisions on an individual basis. Primary Care Trusts have been put in a very difficult situation with their budgets already stretched to capacity."
	If the point of the Secretary of State's intervention was to end the postcode lottery for Herceptin, where is the evidence that that has been achieved? If it was not designed to do that, will she explain to the House what the point of her intervention was?

Steve Webb: The hon. Gentleman is making a measured contribution, but is he saying that, if he were the Secretary of State for Health, he would ask NICE to appraise unlicensed drugs, or that he would require PCTs to pay for Herceptin and would provide central funding for that?

James Gray: Before he does, may I ask my hon. Friend whether he is not simply astonished that the hon. Member for North Swindon (Mr. Wills), in making his intervention, did not mention his constituent, Anne Marie Rogers, the lady whose request for Herceptin was turned down by Swindon PCT? Is not that odd? Is the hon. Gentleman saying that he likes local decision making that goes against his own constituent?

John Baron: I do agree. As I said, bowel cancer is the poor relation among cancers, and that has been demonstrated by the lack of response from the Department on some of the issues that various charities have raised about the screening programme. I hope that the Government will shortly put that right.
	On prostate cancer, various studies have cast doubt on the effectiveness of the prostate-specific antigen test, which is why we have called on the Government to give leadership to international efforts to find a reliable test for this disease, which kills almost as many men in the UK each year as breast cancer kills women. In the meantime, the prostate cancer risk management programme supports GPs in offering men an informed choice about PSA testing. However, many GPs are not even aware that support tools exist. That, too, needs to be put right.
	So far we have discussed improving survival rates, but there is also a need to transform the quality of life of cancer patients. There needs to be better recognition by Government that because more patients are living longer with cancer, cancer needs to be treated as a long-term medical condition. Patients should be given support to manage their own care as much as possible and to make informed choices about treatments where appropriate. Access to information is crucial for people living with cancer and is vital if patients are to be put in the driving seat. Yet communication issues continue to be a common cause of complaint for people with cancer.
	According to the recent Public Accounts Committee report, one fifth of patients are not made fully aware of the potential side effects of treatment. About 40 per cent. of cancer patients were not informed about cancer support or self-help groups. As well as emotional support, patients should also receive, as a matter of right, information about entitlements to benefits.
	According to Macmillan Cancer Relief, three quarters of patients do not receive such advice. The last thing that patients undergoing treatment require is to have to worry about not paying bills because of low uptake of benefits to which they are entitled. Another failing of the system is that it does not adequately address what I call the black hole between health and social care, into which too many patients fall without the care and treatment that they need. The gap needs to be bridged. That is why individual needs should be assessed on a holistic basis with professionals and health and social care staff working together through multidisciplinary teams.
	Specialist clinical advice and support is also extremely important. Currently, Britain has too few specialist cancer nurses. We believe that NICE should be instrumental in drawing up holistic standards and entitlements to care that address the emotional and information needs of patients throughout the entire patient pathway, and so bridge the gap between health and social care. These standards would be for the whole journey, including, perhaps, giving patients the right to die at home if they so wish.
	These standards should also be enforceable. One way of achieving that would be for clinical guidelines to be the basis of contracts between NHS commissioners and providers. In short, we should aim to create a culture of entitlements to care. For example, we on the Opposition Benches are increasingly attracted to the idea of an information prescription given by GPs or specialist nurses—I am pleased to say that the Government are picking up on this—as the starting point of patient empowerment. Expertise in meeting these challenges and improving the quality of patient care already exists in the voluntary sector, and should now be harnessed by the NHS in meeting more robust professional guidelines set by NICE.

John Baron: In short, we very much agree with that. That is one criticism of the decision involving Alzheimer's drugs, in that it concentrated on health costs and benefits. The decision should have focused also on social costs and benefits, so as to bridge the gap. Cost savings could then be made with the provision of good standards of care in viewing the whole journey to the end, as it were. That is one of the faults of the system at present. It is focused too much on health and we need also to consider social care.
	Reducing inequalities of outcome is not only a matter of improving survival rates. The battle against cancer must increasingly be fought by increasing awareness of risk factors and influencing lifestyle choices. This is the importance of prevention. Smoking is by no means the only risk factor that is associated with cancer. We must now put the focus on factors such as obesity, which causes about a third of all cancer deaths. Mesophelioma affects a new generation that are not aware of the risks of asbestos. They are embarking on potentially dangerous do-it-yourself renovations of old buildings, for example. There is a need for better warning about this deadly disease. These facts can be used powerfully to argue for a much better public health and awareness campaign to tackle health inequalities. We as a party were pledged to put these themes at the heart of our policies if elected last year.
	As part of its new public health role and alongside communication campaigns on the symptoms of cancer, we believe that NICE should be involved in drawing up an evidence-based awareness programme of how people can alter their lifestyles to reduce risk.
	The present situation is unacceptable. Despite extra investment and some improvements, Britain's cancer survival rates are still among the worst in Europe. The Government's targets focus on the front end of the patient pathway to the detriment of the latest treatments, which have been neglected. Waiting times for radiotherapy, for example, have undoubtedly increased, but the Government refuse to monitor the situation. There is still a postcode lottery in access to drugs, with British patients benefiting from new treatments later than their European counterparts. Guidance from the National Institute for Health and Clinical Excellence on technologies and standards of care has not been universally implemented.
	The Secretary of State's intervention over Herceptin unfairly raised the hopes of women with early-stage breast cancer. By failing to make specific funding available, she has put primary care trusts in an impossible situation, and she has disappointed patients. Meanwhile, services have not yet fully recognised that cancer is increasingly a long-term term condition, and should be treated as such. The black hole between health and social care needs to be addressed. In future, decisions about cancer services should be taken as much as possible by clinical experts from NICE, rather than by politicians in Whitehall.
	The NHS has been a political football for too long. It is time for politicians to step back, and allow the medical professionals to get on with the job. NICE should take on a much more ambitious role in drawing up guidelines on entitlement to care. Those standards should take account of patient needs on a holistic basis, including the need for information and emotional support, and they should join up health and social services effectively. Standards must cover the entire patient journey from prevention and awareness to the later stages of curative and palliative care and, like technology appraisals, they should be enforceable. To end the postcode lottery in access to drugs and treatments, NICE guidance appraisals and recommendations should be made alongside resource implementation assessments so that national guidance is realistic and successful, enabling us to end the unfairness inherent in the system.
	In short, it is almost a crime that, despite a massive increase in funding, cancer services still lag behind their European counterparts. We need an ambitious programme for the future of cancer services and a fresh approach that puts patients in the driving seat by providing them with an entitlement to standards of care, as decided by medical professionals, not the politicians; by raising treatment standards throughout the patient pathway; and by recognising quality-of-life issues, which are important to patients. For those reasons, I urge the House to support the motion.

Owen Paterson: If we have a national plan, could the Secretary of State explain to my 10-year-old constituent, Katie Morgan from Whixhall, why her mother, Susan Morgan, and another constituent, Mrs. Margaret Bradford, are today at a public meeting in Shrewsbury trying to raise money for a £47,000-per-person Herceptin treatment although that treatment is available two miles away in Wales and 10 miles away in Staffordshire? If we have a uniform comprehensive tax system, as the hon. Member for North Swindon (Mr. Wills) said, why do we not have comprehensive provision of this life-saving drug? Mrs. Morgan has been told by the PCT: "Your circumstances are not exceptional." Yet this is a death-dealing disease.

Patricia Hewitt: I was not going to mention those points, as there is so much to cover, and I am sure that the hon. Gentleman will contribute to the debate on those matters later.
	We are making remarkably good progress towards achieving the targets that we have set for prompt first treatment. Between July and September last year, nearly 95 per cent. of patients had commenced their first treatment within 31 days of being diagnosed, and more than 80 per cent. of patients were treated within 62 days of being referred urgently by their GP. There is still much more to do on that, but we have made remarkable progress already.
	I want to deal with the issue of cancer drugs, and particularly Herceptin, which has rightly been a focus of much of the debate already. I pay tribute to the superb campaigning of Barbara Clarke—who is taking an interest in this debate—and other women. When we heard the results of the initial clinical trials last year, which suggest that Herceptin can make a very significant difference to perhaps one in four women who are HER2 positive and have been diagnosed with breast cancer, we immediately considered the implications for the national health service. In particular, I took steps, with the support of Professor Richards, to ensure that HER2 testing will be available across England to all women diagnosed with early-stage breast cancer, so that they and their clinicians will know whether they might be able to benefit from the drug.
	The hon. Member for Billericay is right, however, to point to the difficulties that arise with drugs, not only Herceptin, that are neither licensed nor evaluated by NICE for use. We have made it clear as general guidance for many years that no primary care trust should refuse any treatment on the blanket grounds that it has neither been licensed nor evaluated, because it is entirely possible for a clinician to prescribe treatment that is neither licensed nor evaluated—or that might have been licensed but not evaluated—and for a primary care trust to fund that treatment. In the light of the risk that Herceptin might be ruled out because it was not licensed, not evaluated, or solely on grounds of funding, I added to the guidance already issued by making it clear that primary care trusts should not refuse Herceptin purely on grounds of cost.

Patricia Hewitt: I was about to explain why we cannot do what the hon. Gentleman suggests at this point. In fact, I am not sure what he was suggesting; I think he was quite confused about it. He asked for national standards. That was our aim in setting up NICE: we wanted to end the lottery of postcode prescribing. NICE, however, cannot evaluate a drug before a licence has been applied for. It simply does not have the information that will enable it to evaluate the drug if the manufacturers who have that information from the clinical trials have not yet submitted it to the licensing authority.
	Although, as the hon. Gentleman says, Herceptin has been licensed for some time to treat late-stage breast cancer, it has not been licensed for early-stage treatment. When a fast-track licence was requested from the licensing authorities, the clinicians involved in the decision took the view that it would be wrong to put Herceptin through a fast-track process for early-stage treatment because of serious concern about side-effects relating to heart disease. That is not a worry if a woman is in the late stages of breast cancer, but it can be of significant concern if the woman is in the early stages.

Patricia Hewitt: I will be guided by you, Mr. Deputy Speaker. However, my hon. Friend has raised an extremely important and difficult case, to which I referred in a written statement earlier today. As an appeal is pending, I do not think it would be appropriate for me to comment on the individual case, which is of course particularly difficult and painful for the individual concerned and her family. I think we all recognise that.
	As I have said, NICE cannot begin to evaluate a drug or a new application before a licence has been applied for. What we did—I pay tribute to the Minister of State, Department of Health, my right hon. Friend the Member for Liverpool, Wavertree (Jane Kennedy), who did much of the work—was enable the NICE evaluation to be speeded up, for Herceptin in particular but also for a number of other drugs, especially cancer drugs. We did that by ensuring that, rather than having to wait until the licence is granted, in cases such as this NICE can begin its evaluation as soon as the licence is applied for. I can confirm that it has begun its evaluation of Herceptin, following Roche's recent and welcome application for a licence.
	The first five drugs to be subjected to the new faster process—the single technology appraisal by NICE—are cancer drugs. We expect the evaluation of Herceptin to be completed within a few weeks of the granting of the licence, but until the evaluation has been completed and the licence granted, it would be wholly wrong for me as Secretary of State to overrule or prejudge the decisions of either the licensing authority or NICE. The hon. Member for South Cambridgeshire appeared to be saying that I should not do so. It is a pity that he has not supported me.

Andrew Lansley: The question surely is this. The Secretary of State chose to intervene last October. It surely cannot be her proposition that primary care trusts are obliged not to refuse treatment on grounds of cost alone. She intervened in respect of Herceptin. When NICE conducts an evaluation, it automatically feeds through into the resources that are made available to PCTs. There is no NICE evaluation. Therefore, no resources to support Herceptin are allocated to PCTs in their overall allocation. The Secretary of State gave the impression that PCTs would be funded to provide Herceptin if they thought that it was clinically appropriate, but she did nothing of the sort.

Patricia Hewitt: The hon. Gentleman is wrong. What I said at the time I made my statement was that I recognised full well the difficult financial position that some primary care trusts found themselves in, and that they would have to make difficult decisions on priorities in order to ensure that Herceptin was not denied purely on grounds of cost, but I think that he labours under a misapprehension. As we have set out clearly, when NICE evaluates a drug and makes a positive recommendation, the NHS then has three months to ensure that its recommendation is followed. However, the NHS is expected to do that within the funding that it has already been given. There is not a separate pot of money sitting in the Department of Health waiting to be allocated as each NICE evaluation is made.
	We have given primary care trusts, the local NHS, more money than ever before and devolved to them some 85 per cent. of the total health budget—a devolution of resources that I would have thought the hon. Gentleman supported—it is simply not possible to say, for each new drug that comes along, when it is positively evaluated by NICE, "Here is more money for that drug." It would not be a sensible way to allocate resources.
	The resources are allocated in a single pot. They are not ring-fenced for a particular drug. They are not even ring-fenced for drugs as a whole. It is up to the local NHS, the PCT, to decide its priorities and to get the best value for money to ensure that patients receive the best possible health care and that funding is released for new drugs and therapies as they become available.

Patricia Hewitt: I am sorry but the hon. Gentleman is wrong. I was very careful in everything I said on the subject last year not to pre-empt NICE. If he cares to ask Professor Mike Rawlins, the chair of NICE, he will find that Professor Rawlins and I are in complete agreement on that point.
	As I said earlier, we have said for some years that PCTs should not deny or withhold treatment on a blanket basis—simply on the grounds that a drug is neither licensed nor evaluated. In addition, I have specified that they should not withhold funding for Herceptin on a blanket basis purely on the ground of cost; rather, they must consider each individual case. If a PCT decides not to fund such treatment, that decision can of course be reconsidered on appeal by the clinical exceptions committee. The more that such decisions are taken by clinicians, the better.
	I shall end my remarks—I am conscious that a number of colleagues wish to speak—by referring to the surveys carried out by the National Audit Office between 2000 and 2004, which have confirmed the significant improvements in cancer treatment to which I have already referred. They show that fewer patients reported a deterioration in their condition while waiting for treatment. Of course, fewer patients now wait weeks or even months for treatment—a wait that was, I am afraid, a feature of cancer treatment in the past. Perhaps most crucially of all, nearly nine out of 10 cancer patients reported that they were treated with dignity and respect at all times.
	We are just halfway through implementing the national cancer plan. As I believe Members in all parts of the House will accept, we have already made great progress, but as I would be the first to acknowledge, there is a great deal more that we have to do. But given our continuing investment in cancer services and the record sums going into the national health service; given our confidence that by the end of 2008—after two more years of record increases—we will have achieved the European average in health care funding; given the extra specialists, the new drugs and the continuing drive for an improved patient experience and proper support throughout the cancer journey; given the provision of better advice and more choice and control for patients; and given the provision of more care in or near the home, as reinforced by our recent White Paper, I believe that we are well on the way to making Britain's cancer services among the best in the world.
	All the progress that we have already made and will make as we continue on this course in the years to come would be jeopardised by the new fiscal rule announced by the Leader of the Opposition, the right hon. Member for Witney, as confirmed in his most recent statement. That "proceeds of growth" rule would inevitably mean cuts in the NHS budget—thereby reversing the progress that we have made—longer waiting lists, fewer specialists and poorer services for cancer patients.
	Much has been done but there is more to do and we have an absolute determination to do it. I commend the amendment to the House.

Steve Webb: I know that the House is keen that Back Benchers have the chance to speak before the winding-up speeches begin, and although this is a very important topic that, to judge by the contributions that we have heard so far, deserves a lot more time than has been allocated to it this afternoon, I will curtail my remarks, not least in the hope that my hon. Friend the Member for Dunfermline and West Fife (Willie Rennie) can catch your eye, Mr. Deputy Speaker, and make his maiden speech.
	I want to focus on the crucial issue of cancer drugs and access to them, but first I want to place on the record my support for the 10-year cancer plan, which, as has rightly been said, has made an important contribution. However, I hope that the Government will say whether and when they plan to renew and refresh that plan, because we do not want it more or less to expire, and then to be presented with a new 10-year plan. Cancer treatment provision and cancer prevention is a long-term process, so we need a long lead time into the next stage of the cancer plan. I therefore hope that the Minister can tell us this evening when we will get the shape of the next plan, rather than waiting until the current one ends. We need a longer-term horizon than that.
	I turn briefly to the important issue of the "prescription for change" campaign by Breast Cancer Care, which has highlighted an anomaly. People diagnosed with breast cancer or other cancers would once have died shortly thereafter; now, they can expect to live for much longer, but as a result they suffer prescription charges, whereas people with other conditions, such as diabetes, do not. Prescription charges are causing problems for cancer patients. For example, the Minister may not be aware that a Breast Cancer Care survey found that 15 per cent. of cancer patients had not taken up the prescriptions given to them by doctors because of their cumulative cost. There is an arbitrariness in the prescription system, for example between diabetes and cancer. That was not so important in the late 1960s, when the rules were drawn up, but it is a problem now. The present system can be defended only on the grounds that it is the one that we have got and that changing it would open up a can of worms. However, that is not a good enough reason not to look at it.
	I shall focus on the question of access to expensive new drugs. We will talk about Herceptin today, but there will always be another new drug just around the corner. Herceptin is going through the NICE licensing process for use in early-stage breast cancer, and we hope that it will soon be approved, but our answer to the question of access must work every time, for each expensive new treatment that comes along.
	My comments are informed by a meeting that I had yesterday with oncologists from Addenbrooke's hospital. They wrote to me and other hon. Members last July about the inaccessibility of Herceptin, and said:
	"As a group, we are conservative"—
	with a small "c" in that context, I am pleased to say—
	"in our response to new treatments. We usually strongly resist pressure to switch our patients to new and expensive drugs for marginal benefits. But the recent trial data demand immediate action since these are certainly the most stunning results that any of us has seen during our entire professional careers."
	It is interesting to note that, since the oncologists wrote that letter, their patients can now access the unlicensed drug Herceptin for early-stage breast cancer. It was their clinical judgment that that should happen, but other PCTs have concluded that that would not be the right thing to do for clinical reasons. How can such matters be dealt with systematically? That is the important question, as our constituents sense that the present requirements are unacceptable.
	The hon. Member for Billericay (Mr. Baron) said the same, but did not propose a solution. I agree that it cannot be right that a woman suffering from breast cancer should have to go to court to get Herceptin. The hon. Member for North Shropshire (Mr. Paterson) has intervened more than once to say that it cannot be right either that a woman who happens to live in Shrewsbury cannot get Herceptin, while one who lives in Staffordshire or somewhere else nearby can. Neither circumstance can be right, but we have not heard how such inconsistencies are dealt with in connection with drugs that are neither licensed nor approved by NICE. I shall make my own suggestion about that in a moment.
	Some key questions on Herceptin remain unanswered. First, what have the Government done to try and get it more cheaply? On average, the NHS pays more for drugs than most other health services—a fact confirmed to me in a written answer from the Department. Have we used the buying power of the NHS to beat down the providers and get a better price? That approach must be both sensible and desirable, although I understand that the producers need their research budgets and an incentive to carry out research. That means that there is a limit on how far prices can be brought down but, if other health services can do it, why cannot ours?
	Secondly, the hon. Member for Billericay said that other European countries adopt new drugs much earlier than we do. Why is that? Many other European countries have better survival rates than the UK, and that is very closely linked to our failure to take up new drugs earlier. Why do the Government think that our health service is, on average, slower to adopt new treatments? What assessment has been made of that?
	On unlicensed drugs, I stress that I am speaking for myself, and that I do not ascribe my views to the consultants to whom I spoke yesterday. However, they pointed out that unlicensed drugs are used all over the place and said, "Paediatricians do it all the time." Licensing is for the benefit of patients, and is about patient safety. If patients are told that the trials and tests of a drug remain incomplete and that there is a risk attached to its use, they might still conclude that they are not willing to accept the risk of not using the drug. In those circumstances, why should the patients be told that they cannot take an unlicensed drug, simply because it is unlicensed? That cannot be right.
	The fact that a drug is unlicensed should not be a barrier, but we do not have a system for the systematic appraisal of unlicensed drugs by clinicians who want to give them to their patients. Such a system would mean that the use of new drugs would not vary by postcode, or require people who want them to go to court. That is the sort of system that we need, and I shall make a suggestion to that effect in a moment.
	I share the concern that has been expressed about the Secretary of State's intervention last October. She made a statement on 5 October that reiterated the undertaking that Herceptin would be fast-tracked when it was brought forward for licensing. Obviously, we welcomed that. However, that statement, subsequent clarification by the Department of Health on the same day and the Secretary of State's speech to Breakthrough Breast Cancer have, according to a PCT guidance note on access to Herceptin:
	"raised considerable expectation that NHS patients will, from now, be prescribed"
	early-stage Herceptin
	"even though the announcement relates only to provision of testing".
	Whether the Secretary of State likes it or not, she clearly raised expectations. She must accept that, because there is plenty of evidence that people heard that on the news and concluded that she was telling trusts not to refuse to prescribe it. I know that she said that they were not to refuse to prescribe it on cost grounds, but does she seriously think that if Herceptin cost £1 a dose any PCT in Britain would refuse its use to clinicians who asked for it? That is patently not so. If clinicians had judged that Herceptin, although unlicensed, was in the best interests of their patients—and the patients knew the risks and were willing to take them—no PCT would say no in those circumstances.

Andrew Lansley: Strictly speaking, some clinicians would say no in those circumstances. For example, in the Thames Valley strategic health authority, advice has been derived from a joint professional group that clinicians should say no to Herceptin, on the grounds of the risk associated with an increase in coronary heart disease.

Steve Webb: I was talking about primary care trusts saying no when clinicians said yes. If clinicians have a patient whom they believe would be ideally suited to the treatment, they have explained the risks and the patient is prepared to take those risks because the alternative would be worse, the money would be found for Herceptin if it were not so expensive. That is cost rationing, and it is no good pretending that this is not about cost. The Secretary of State told trusts not to say no on grounds of cost alone, but that clearly raised expectations that cannot be met. That is the danger of the Secretary of State intervening as she did.
	We have all heard about the North Stoke case. How can it be right that one person gets the treatment because they have got on the news, the Secretary of State has thrown her weight around and, the next day, the PCT changes its mind, but another woman, who does not get on the news, does not get the treatment? That is not a rational way to allocate those treatments.
	My local PCT in south Gloucestershire does not fund Herceptin, on clinical grounds, because there is an academic study that says that four years down the track the chance of surviving is enhanced by only 5 per cent. However, that study was based on a broad category of women. I put that point to the consultants at Addenbrooke's yesterday and they said that out of the big sample one could pick sub-groups who have a far better chance of survival. The drug is ideally suited to some women, for whom the statistics would be much better. My local PCT has picked one study and interpreted it in a particular way and will not prescribe Herceptin, but if my constituent who needs the treatment were living in Cambridge, she would get it. That cannot be acceptable.
	It is all very well identifying the problem, but what should we do? We need a mechanism for allocating unlicensed and unapproved drugs. We cannot continue with the random and arbitrary approach that we take now. That has to be done nationally. The hon. Member for North Swindon (Mr. Wills) was right to identify a conflict between a belief in localism, local discretion and responsiveness to local circumstances, and consistency and avoiding postcode lotteries. On many things, my colleagues and I are on the side of the localists. We want local discretion over patterns of service and provision. However, I do not think that any of our constituents believe that it is right that whether a patient gets a drug should depend on where they live. That does not come into the category of decisions that our constituents believe should be made case by case, on a local basis. Therefore, we need a central evaluation process for such treatment, pre-NICE. The alternative is arbitrariness—randomness, going to court, postcode lottery—on treatments that could save lives. It must be one or the other. We cannot have both.
	That arbitrariness so offends our constituents' sense of natural justice that we cannot go on. Yes, the problems with Herceptin will be sorted in six months—we hope—but the next set of problems will not be. Clinicians tell me that Avastin will be the next cancer wonder drug and that it will make Herceptin look cheap, so we have to tackle the issue. Such drugs will first be unlicensed and then licensed but not approved. The faster the NICE approval process, the shorter the pre-NICE process I suggested, but it will have to exist, otherwise there will be only the arbitrariness and unfairness that we all feel offends against our sense of natural justice.
	It is no good pretending that there will not always be rationing, but it must be systematic and consistent—

James Gray: I am glad to follow the right hon. Member for Oxford, East (Mr. Smith) and I agreed with much of what he had to say, particularly when he was talking about the great advances in cancer care in England in the past 10 or 20 years. However, quite frankly, it would have been rather surprising if those advances had not taken place. It would have been a scandal if we had been saying in today's debate that cancer services were precisely where they were in 1997, 1987, or 1967.
	Although things have got a great deal better, I disagreed with the right hon. Gentleman when he became party political and seemed to indicate that that change was because of the Labour party. That was rather reminiscent of comments made by the right hon. Member for Airdrie and Shotts (John Reid), who, at the Labour party conference in 2004, said:
	"in the first 6 years of this government, the death rate from cancer is down by over 10 per cent . . . Isn't that just the sort of thing Labour came into government to do? . . . Thousands of real people walking the street who would not have survived under the last Tory Government."
	That sort of remark—and one or two of the comments made by the right hon. Member for Oxford, East—is quite wrong. The achievements have been made thanks to scientists, clinicians and doctors.
	I speak from personal experience. About this time last year, during the general election campaign, my wife was diagnosed with breast cancer. We were somewhat discombobulated by the surgeon, who told us that the operation would be on 5 May. We had to tell him that we would be otherwise engaged then and would have to delay the operation by a week or so. I am glad to say that the subsequent care that my wife received was excellent in every possible way and that she has been given a clean bill of health. I pay tribute to the care workers at the Royal United hospital in Bath, and at Chippenham, Swindon and elsewhere, who achieved that. However, I have to say—I hope that this will not disappoint the Minister—that I do not thank the Labour party for achieving my wife's good health; I pay tribute to the scientists and health workers. It is probably wrong to reduce the matter to a party political issue.
	That is why I welcome the positive tone of the motion. We are saying how well things have gone: a lot of money has been spent and a great deal has been achieved. However, the truth of the matter is that there is an enormous amount more to achieve. We do not know the cause of breast cancer. For example, why does it almost not exist in the far east? Is that something to do with health and diet? It probably is. Why is there a high incidence of breast cancer among left-handed women? We do not know, but it would be useful to find out. We need to spend more money on research. My wife happens to be left-handed, which is why I know that statistic.
	On care, of course it is good that we have a target of people being seen by a specialist 14 days after they are first diagnosed by a GP, but the average waiting time in 1997 was only 11 days, so the much-vaunted 14-day target is not particularly useful. What it does result in, as I discovered when I accompanied my wife on that fateful day, is a waiting room packed full of people. I said to the surgeon, "Why are the waiting times so long? Why do we have to sit here from 8.30 am to 2 pm before being seen by you?" He said, "That is to achieve the two-week target. We cannot lay down when people are diagnosed. They have to be seen within two weeks and the clinic has to be jammed full to achieve that target. If we were allowed a certain flexibility in terms of days, it might be easier to organise timetables better." The targets may sometimes have the wrong results and are not all that they are cracked up to be.
	We have to see some improvements in waiting times for treatments. My wife heard today that she will receive her radiotherapy within four weeks, but many women are still waiting for six weeks or longer. Surgery and chemotherapy tend to be done in good time, but there is a long delay on radiotherapy, even though it is an important part of the treatment.
	There has been a terrific muddle with the prescribing of drugs. We have heard a great deal about Herceptin, but the same situation will apply over the years to come to a variety of other groundbreaking new cancer drugs. We need to find a way in which NICE can license and approve them speedily. We cannot have another situation like the one last October when the Secretary of State encouraged women at the Breakthrough Breast Cancer event—I was there—to think that Herceptin would become available, only for them to discover that it will become available only if there is plenty of money to pay for it, which there is not.
	The experience of Anne Marie Rogers, in my neighbouring constituency of North Swindon, is a vehement comment on the awful effects on women who are discovering that they may face a shortened life as a result not of anything to do with clinicians, but of a shortage of money and of Government decisions. An awful lot needs to be done in that respect and in relation to radiotherapy. In particular, an awful lot needs to be done on research.
	I pay tribute to the very high standard of care that my family have benefited from in the last 12 months, and I think that we see that across the book. I do not accept that that is anything whatever to do with the Labour Government. It seems to me that science is developing quickly and that wonderful support and services are provided by doctors, nurses and researchers in our hospitals, and I pay tribute to them. I very much hope that, 10 years from now, we will have seen the statistics improve even further, and that when a Conservative Secretary of State is standing at that Dispatch Box he does not fall into the easy trap of claiming that as a Conservative victory.

Ian Gibson: This has been a very British debate. We should really be celebrating the excellent and magnificent work that has been carried out in cancer services since 1990, but particularly since 1997. I speak as someone who has chaired the all-party cancer group since 1998 and who worked in the field for many years, with patients and doing research.
	You may remember, Mr. Deputy Speaker, that you and I once put some bricks into a wall around an accelerator at Ipswich hospital, some time after a Labour Government came to power. There are many such stories to be told.
	Why did I set up the all-party group? People were in the habit of setting up an all-party group for every part of the body that got cancer. Somebody once asked me if they could have an all-party group on right-knee cancer, and at that point I said, "No way. You can work within the bigger all-party cancer group. There is no reason why things cannot be considered under that umbrella."
	I remember, too, a Select Committee report on cancer in the 1990s, after the Labour Government came to power, which came up with the idea of joining two major cancer charities, the Imperial Cancer Research Fund—hon. Members will remember that name—and the Cancer Research Campaign. At a meeting we were told by a man who became a Nobel prize-winner in this country, a scientist backed by British money and British technicians and workers in various universities and institutes in this country, that those two charities could never merge. One reason was that they were like Omo and Daz. That did not fool me because those two products are made of the same chemical substance and can be mixed.
	The scientist also said that the charities would not get as much money if they came together. They fund most of the research in this country, and that came about through support not only from the Select Committee but from the Government. The charities get twice as much money now as the total that they got acting singly, which means that more research is being done, more projects are being funded and more young people are being given the opportunity to discover things. Although it is true that science has moved on and discovered much in cancer, it has been supported to a huge extent by the Labour Government.
	I sometimes feel like going back and doing research because I have had many grants turned down, and I would have a much better chance now. I see that the Minister agrees that I should go back, before a few more votes are taken. I do not think that cancer research has ever been in a better state. In 1992, to give the Opposition credit, they implemented the Calman-Hine report so that the process started, but the acceleration really happened in 1997 and 1998.
	I think too that there is a new understanding, and that is the essential feature. We used to teach students that genetics had nothing to do with cancer; it was all environment. Genetics has everything to do with cancer. We understand the causes of a genetic change that brings about a rogue cell that develops into a cancer. [Interruption.] I see that the Opposition are coming in to listen.
	Understanding those genetic changes allows people to target drug development. Herceptin is one such drug, Glivec is another, and there will be many more. We are also going to understand the genetic basis of who will benefit from treatment with a drug and who will not. That has been pioneered in Dundee using a certain drug. Now, in this field, genetics is all, and making that discovery has given us Nobel prizes—prizes that, incidentally, were won working not on cancer cells but on yeast cells. That shows that basic blue-skies research can often turn up things that have a medical advantage, and we should remember that.
	We have had two British Nobel prize-winners at a time when we thought we were losing out. There are more to follow. I predict that, in the not-too-distant future, work being done at Dundee university will win a Nobel prize. Scotland deserves another one.
	There is a new subject called bioinformatics, which is all about fancy computers, that allows us to look at amazing pieces of information. There was a shortage of people when bioinformatics were first discovered. We are now making up for that shortage by training people in colleges and elsewhere. We are punching our weight in this area. We shall make many more discoveries and we are supporting young people who are trying to develop career structures. We are enticing them. We are trying to change science in medicine that is taught in schools. Why should pupils in schools not be taught about cancer, for example? That is a good example of the things that we have done, the things that we can do and, if we get down to it and get more support from Government, the things that will happen in future. We maintain our position very well throughout the world.
	I give credit to my right hon. Friend the Member for Oxford, East (Mr. Smith), who mentioned the work at Oxford. He did not mention—I was proud of this—a young 16-year-old who was leading a demonstration at Oxford that was supporting limited animal experiments. We are not saying that all work should be done with animals, and perhaps some of it should be done with computers and tissue cells, for example. The right to be able to do that is so important. Before a licence, there is a need for the toxic test. We do not stick drugs into patients and hope that they do not die. Certain tests have to be carried out in the hope that results will be obtained before the licence.
	The changes that are coming about in scientific discovery will make a real difference. Quite often in science and medicine, discoveries happen long before politicians, particularly those who are lawyers, can pick up on what they might mean in terms of new laws and regulations, for example. We have genetic modification and stem cells. Many of us knew about stem cells before the many debates in this place that led to us ensuring that we could continue with research. We are hopeful that that research might pay off.
	Much has been said about the cancer plan that came through for 10 years. We are halfway through that. Many new people have been appointed. Consultants are pouring out of oncology departments in our hospitals, and there are more to come. This is real encouragement. For the health service in general, such developments have stimulated mental health people and those who work in cardiology, heart disease and so on. How did these people do it? I will tell the House: politicians, scientists and medics worked together. There is huge team work. There are 20 cancer research charities and voluntary groups that meet once a week in this place to discuss various issues from a professional, knowledgeable position. That is what we have created since 1997, and that is important. Let us do away with competition and get people working together who have the best experiences.
	I heard a woman from the Christie in Manchester talking about best practice there. She was telling 19 other people how it was done. That is excellent, and that atmosphere should be encouraged. We have talked about NICE and quality of life. People with cancer, in their last few years or days, experience tremendous fatigue. We can do things about that. There is the stimulation of blood, for example, which will stop these people being tired. NICE should be asked to examine that.
	Of course, NICE will evolve. It will learn by some of the mistakes that have been made. That is what it has all been about. Thank goodness that NICE has been in place to give us some evidence-based knowledge of what we do and of what we do not know. That knowledge will increase.
	The vision that we have in the all-party group—please join it—is how we are going to take things on. We realise that cancer is a complete journey from the early diagnosis, through treatment and then on to care in hospices, including palliative care. The passport needs to be examined. There should be no piecemeal approach when it comes to putting in money. The patient should be considered throughout.
	I am excited about what is happening, but I think that there is more to do. What we have managed to do in providing better cancer services will stimulate us to do even better, as we learn more. That knowledge will come from science, medicine and practice. We have an enthusiastic work force who want to try to do things. In the light of experiments and clinical trials—more and more of that is going on with the necessary resources—we shall learn best practice.

Sharon Hodgson: I must continue with the happy tone by congratulating the Government on their fantastic record of investment in cancer services, especially the first cancer plan, which we have discussed. It was published in 2000—[Interruption.] I see that some of the Liberal Democrats are leaving now. The plan has meant that more funding than ever has been pumped into cancer services—an extra £280 million in 2001–02, increasing to £570 million in 2003–04. I do not have the most recent figure but I am sure that it is even higher.
	I must also draw attention to our fantastic record on waiting times, which have been reduced to two weeks to be seen by a specialist, a month for diagnosis and two months for treatment. That cannot go without recognition in the debate.
	I am sure that the hon. Member for Dunfermline and West Fife, as a new Member, will be asked in what he will specialise. I gave many answers to that question as the weeks went on. I had no idea in what I would specialise, although I had many interests and many important matters came my way. However, the decision was taken out of my hands when my best friend, Joanne Smith, was diagnosed with breast cancer at the age of 34. At the time, she had a two-year-old and a seven-year-old, who are now a little older—one has had a birthday since then—but she was a young woman with a young family. The diagnosis was a tragedy, which has totally coloured my first year as a Member of Parliament.
	Joanne was seen within 48 hours by a cancer specialist at my local hospital, the Queen Elizabeth hospital. Her consultant, Dr. Clark, has been incredible and her treatment has been fantastic. She had a double mastectomy and a terrible course of chemotherapy, which debilitated her. Nobody goes through chemotherapy lightly, but because she was so young she had to have such a high dose that it was shocking to see her suffer through it.
	I immediately began campaigning for Herceptin and joined the all-party group that my hon. Friend the Member for Norwich, North (Dr. Gibson) mentioned earlier. I was keen to get my local cancer network—the northern cancer network—to reverse its decision not to prescribe Herceptin. It made the decision because the drug did not have National Institute for Health and Clinical Excellence guidance. However, after campaigns by me and other hon. Members throughout the country and the region, the decision was reversed. When I asked why the network had reversed it, it cited the comments by my right hon. Friend the Secretary of State that lack of NICE guidance should not be an excuse for not prescribing the drug and that it was up to individual PCTs.
	The PCTs in my area recognise that they have the freedom to make such decisions, but they do not do that in practice because they defer to the northern cancer network. When one questions the northern cancer network, one finds that it defers to NICE guidance. So, although individual PCTs can make these decisions, in practice they do not.

Sharon Hodgson: The hon. Lady makes a good point, but time is short, so I must press on.
	My campaign with my friend got a lot of press interest, and the northern cancer network reversed its decision, on which I congratulate it. My friend started her Herceptin treatment two weeks ago. She is one of the first people in the region to receive it.
	I want to talk briefly about brain tumours, which relates to the hon. Member for Dunfermline and West Fife, whose predecessor, Rachel Squire, sadly died after suffering from a brain tumour. Some other famous people who have suffered from brain tumours are Bob Marley, Elizabeth Taylor, Mo Mowlam and Sir Stamford Raffles. Such tumours account for one death in every 100. Someone who is not as famous as those people is a constituent of mine who is quite dear to my heart. His name is Fred Fergus, and I have been campaigning on his behalf for access to the drug temozolomide, which is awaiting NICE's approval. We were told that that would be decided by the end of the year, but I recently received some information on an appraisal consultation document—an ACD—put out by NICE. Apparently, NICE is recommending that the therapy should not be provided on a subsidised basis on the NHS in England and Wales for patients with newly diagnosed, high-grade malignant brain tumours. Perhaps the Minister will tell the House why.

Vera Baird: My hon. Friend has been involved in two campaigns. I was involved in one in Redcar relating to a drug called Alimta, which has been licensed but not NICE-ed, as it were. It is used to treat mesothelioma, which is a terminal illness. NICE was not even going to evaluate it until October 2007, but that was useless for the men suffering from the disease who had only months to live. However, NICE is now introducing a fast-track procedure. When the Minister responds to the debate, will she tell the House whether it is intended that all cancer drugs should go through that procedure?

Sharon Hodgson: I thank my hon. and learned Friend for that intervention.
	Mr. Fergus is receiving his radiotherapy on the NHS and paying privately for a prescription of temozolomide. He says that it has given him his life back. There has been such a change in him in terms of memory since he has had access to the drug. Obviously, brain tumours affect the brain and memory, but with this drug he can function so much better, which is why I am so concerned about NICE perhaps not approving it.
	I want to move on to another very sad case involving a bowel cancer sufferer. Bowel cancer is responsible for 50 deaths a year in the UK, and it claimed the life of my constituent, Jack Wilson, at the age of 66. He was a retired miner who was hoping to get the drug cetuximab on the NHS. Again, he was told that the drug was not licensed. I have already mentioned the northern cancer network and the process we go through there.
	I am short of time, so I should say that I want an urgent review of the funding of cancer treatments. As the hon. Member for Northavon (Steve Webb) said, there will be another drug, then another and another. More and more are on the horizon and we will have to try to fund them. Taxpayers are entitled to receive the best possible treatment and value for money from the NHS, so we need to examine how such treatments can be financed while retaining the tax base of the NHS and the principle that health care should be free at the point of need.
	There is a specific problem with funding drug treatments—the hon. Gentleman also mentioned this—while they are licensed but before they are NICE approved. There is a strong case for a dedicated cancer charity that would fund specific cancer drugs during that interim period. Also, there should perhaps be a dedicated lottery card. I shall leave those thoughts with the Minister.

Stephen O'Brien: Given that the hon. Gentleman, who is the Secretary of State's Parliamentary Private Secretary, is the only other Scottish Member who has been present for most of the debate, it is a shame that he has made his presence felt from a sedentary position.
	The hon. Member for Dunfermline and West Fife gave us a wonderful and engaging tour of his constituency. I am sure that his constituents look forward to his serving them with all his energy and enthusiasm. I fear that he will have to rely on the Official Report to ensure that his most notable and, I predict, his most challenging constituent, the Chancellor of the Exchequer—who, for some reason, was not present for his speech—recognises what a marvellous new Member of Parliament he has.
	I am glad that the Secretary of State congratulated the Opposition on making this vital subject a priority for their precious time. The debate has been characterised by the concern, care and expertise brought to it by all who have had an opportunity to speak on behalf of their constituents. I am aware that tributes in the House often sound ritual, but I know that I am joined by my right hon. and hon. Friends, and indeed by Members throughout the House, in thanking the countless people in the NHS and beyond it who work tirelessly for and with those affected by cancer.
	My hon. Friend the Member for Billericay (Mr. Baron) made an excellent and constructive opening speech. I could not help being rather amused by the Secretary of State's slight discomfort over having to take the politics out of the NHS, but we were serious about wanting to debate the future of cancer services as a high priority. We heard from many Members on both sides of the House. The hon. Member for Northavon (Steve Webb) talked about the possibility of securing much lower provider costs for the NHS. That is, of course, an important subject, but I was particularly interested in what he had to say about the Herceptin issue. For the sake of brevity, I will give the source for everything that he said about it. It can be found in column 1062 of the 8 December edition of the Official Report, set out wonderfully by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley). He is obviously grateful that it has been read into the record again.
	In a celebration of a local investment to which he wished to draw attention, the right hon. Member for Oxford, East (Mr. Smith) mentioned tariffs that have recently been imposed in a most incompetent manner. I think he found it difficult to refrain from mentioning that. However, he rightly highlighted the uncertainty that that is causing and the quick resolution that is required to clarify the matter. He asked whether the serious deficit in the Oxford Radcliffe Hospitals NHS Trust should be spread among others. He seemed to be shifting the debate as well as shifting the deficit, rather than dealing with the fundamental issue, which is vital to so many of the issues that we face in the NHS.
	The hon. Member for Norwich, North (Dr. Gibson), the chairman of the all-party group on cancer, as ever gave us an enthusiastic tour d'horizon of leading-edge scientific progress in this country. He advanced a wonderful argument for the success of our competitiveness internationally, intellectually and scientifically and then suggested that we get rid of competition. That was an interesting circular argument, which all of us will enjoy pondering once the Official Report is out.
	We heard movingly from my hon. Friend the Member for North Wiltshire (Mr. Gray), who gave his personal testimony, particularly in the light of the difficult and dreadful experience that his wife has been through. I was very pleased, as I am sure all hon. Members were on both sides of the House, to hear that she has been given a clean bill of health and continues to receive the follow-on treatment. He made the important point, which we have sought to emphasise, that it is to the benefit of patients and to the subject as a whole that we take great care not to make it deliberately a party political issue when we look at the opportunities to improve outcomes for cancer survival and treatment.
	We also heard from my hon. Friend the Member for Rochford and Southend, East (James Duddridge). Apart from the slightly interesting start, when he called his Whip bewildering, which struck me as instant career death, he spoke powerfully and made a cogent case on behalf of himself and my hon. Friends the Members for Southend, West (Mr. Amess), for Castle Point (Bob Spink) and for Rayleigh (Mr. Francois) about the cancer network, and what the appropriate size is for the South Essex cancer care centre, considering local conditions. I hope that people at both national and local decision-making levels have taken due account of that strong and well-made case.
	We also heard from the hon. Member for Gateshead, East and Washington, West (Mrs. Hodgson)—that is certainly one of the most confusing constituency titles, with half of each city in it. She said that she spent some time deciding what to specialise in. I felt that she spoke sensitively about her experience as a result of the breast cancer of her friend. The House was helped by hearing of that experience.
	Looking at the future, we have to be clear where things stand today. As my hon. Friend the Member for Billericay said in relation to cancer care services, the present situation is unacceptable. There has been investment and continuing improvements, the Organisation for Economic Co-operation and Development has confirmed that the trend was already well established before this Government took over nine years ago, but—here is the big but—after nine years, survival rates are still among the worst in Europe, and significant inequalities of outcome persist in the UK. According to the Public Accounts Committee report, those inequalities are widening, not narrowing.
	As we have heard today, difficulties have arisen following the Government's efforts to focus targets on reducing waiting times—the front end of the patient pathway. That has led to neglect of later treatment. We face a serious issue: once a patient is on the pathway, the pipeline of time is extending. There is a serious issue in respect of how to deal with the problem involving radiographers.
	It was interesting to note that the future of cancer services is threatened because of the NHS's ballooning deficits. Will the Minister answer the excellent question from the hon. and learned Member for Redcar (Vera Baird) and confirm that there is no diminution or delay regarding the announcement from the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton), as recently as August last year of a £37.5 million bowel cancer screening programme, which was confirmed just 30 days ago? Will she confirm that it will be up and running in April with five centres, not just one, as is being hinted as part of the financial cuts?
	In addition to issues such as waiting times, the size of the work force, the new requirements for benchmarking and the exchange of information—so that clinicians, who are best placed to make such judgments, can draw on the very best of existing practice—there is another big issue that we need to concentrate on. The Secretary of State has had some time in which to deal with the Herceptin issue. On the question of the announcement that she made in October, even if she is arguing that she did not say that she would end the postcode lottery for early-stage breast cancer and that there was no change, therefore, in her Department's policy, one is still left with the following question. Why on earth did she make the statement that she made in October, unless it was made on the ground of cost?
	We were determined to raise today on the Floor of the House the future of cancer care services, because it is a priority. Such services need not merely to be maintained: the trends need to be enhanced, given the debilitating effect that cancer has on so many people in this country. At the moment, the opportunities to enhance the services available are being missed.

Jane Kennedy: This has been a very interesting and useful debate, which the hon. Member for Billericay (Mr. Baron) opened very disarmingly. It is much easier to respond to a straightforward political discussion across the Dispatch Box, but this has been a very thoughtful debate and, in the short time available, I shall try to respond in a way that reflects that fact, and to answer as many questions as I can.
	The cancer plan is a 10-year national strategy of investment and reform, the purpose of which is to reorganise, standardise and rejuvenate cancer services. We are just past the halfway point in implementing it, and looking back—it is appropriate that we do so—I challenge anyone not to acknowledge the clear and impressive story of real improvement. The hon. Member for Northavon (Steve Webb) asked when the next cancer plan will come along. There have been three reviews of the current plan and we may or may not have a further one. I take his point about wanting early warning of when another cancer plan will be considered, but that is some way down the track.
	My right hon. Friend the Secretary of State spoke of the importance of prevention, detection, treatment and care. I do not want to repeat what she said, other than to say that unprecedented investment in new and replacement equipment is helping to improve reliability and access to diagnosis and treatment. We are expanding the cancer work force—I will not repeat the figures, which are in the amendment—and there are more cancer specialists. New training programmes for specialties such as radiography and endoscopy are increasing capacity. Such investment is going hand in hand with reform. Specialist teams have been established across the country that bring together surgeons, radiologists, pathologists, nurse specialists and many others to deliver co-ordinated care to patients in hospitals.
	That brings me to the Opposition's motion, and I have to say that I agree with a lot—indeed, almost all—of it. It is very much in keeping with the opening speech of the hon. Member for Billericay, but I disagree profoundly with the suggestion that we now need a different approach if we are to make further improvements in cancer services. It is appropriate that I deal with this issue specifically. We are close to being the world leader in developing the multidisciplinary approach that I have just described. All these advances are due largely to the cancer plan and to the work of Professor Mike Richards, as my right hon. Friend the Secretary of State said.
	The hon. Member for Billericay discussed at length how the guidance and appraisals of the National Institute for Health and Clinical Excellence should be enforceable, and a number of Members referred to Herceptin and the role of NICE. When I first came into post last summer, the question arose of the length of time that NICE is taking on this issue. We issued a written statement today outlining the exact process for Herceptin, but we must remember that the licensing process—which is very important for this treatment and its application—and the NICE appraisal process are absolutely critical in allowing the health service to take proper decisions on how it uses its resources locally to provide the proper available medicines and treatments. We trust NICE, as an independent organisation, to make those appraisals and to assess the new treatments. It does so in a way that is very efficient and highly regarded throughout the world.

Jane Kennedy: The so-called postcode lottery applies only in the period when we are waiting for a treatment to be licensed. Once NICE approval has been given, the NHS has 90 days—three months—to make arrangements for provision of the medicine. I shall look in detail at the example to which the hon. Gentleman has drawn my attention, and see what can be done.
	The hon. Member for Billericay mentioned the length of time that people have to wait for radiotherapy. He made far too many points for me to answer in the time remaining, but I can tell the House that the Royal College of Radiologists published an audit on 23 February that showed that the situation is improving. However, I accept the criticisms that have been made, and much remains to be done in this regard.
	Even so, I am pleased to be able to tell the House that the Department of Health has exceeded its target of recruiting an extra 1,000 radiographers. More than 1,400 additional radiographers and radiography assistants are now working in the NHS, compared to 2003. That is still not enough: a lot of progress has been made, but we recognise that more remains to be done.
	The hon. Member for Northavon raised a number of points, and asked about the cost of Herceptin. He will be interested to know that the new pharmaceutical price regulation scheme agreement that started in January 2005 will save the NHS more than £1.8 billion on branded prescription medicines over a five-year period. The detail of his question concerned whether the company Roche was offering anything at the moment. Although I cannot comment on that, it is an interesting thought, and I shall be happy to write to him about the matter. Many hon. Members said that the process was arbitrary, but in the long run I do not believe that tinkering with what happens before NICE gets involved will benefit the NHS in any way.
	My right hon. Friend the Member for Oxford, East (Mr. Smith) works tirelessly for his constituents. As he said, quite rightly, he holds the health staff in his town in very high esteem, and I want to answer a couple of the specific points that he raised. He asked whether the tariff applied to cancer services. Under the payment by results programme, hospitals are paid according to the number and complexity of the cases treated. Chemotherapy, radiotherapy and, indeed, palliative care will eventually be included, but they are not included at present, and are treated as specialist services for the purpose of commissioning. I would be happy to talk to my right hon. Friend about the deficits that he described in Oxford on another occasion.
	The hon. Member for North Wiltshire (Mr. Gray) tempted me to be party political, but I shall just echo the words that have been said about his wife and the fact that she has made a full recovery. I am also pleased to hear that her personal experience of the service provided by the health service was good. My hon. Friend the Member for Norwich, North (Dr. Gibson)—

Austin Mitchell: Thank you, Mr. Deputy Speaker. I am most grateful for that permission to remain seated for entirely non-alcoholic reasons. I hope that it will not inhibit the ability of other Members to stand and applaud, as usual, during a speech on the Adjournment.
	I declare an interest, first, in that I am a member of the National Union of Journalists. Secondly, I, too, have been fired by the Yorkshire Post for, I assume, economic reasons; it could not have been because of the quality of the articles that I was writing. Thirdly, I am chair of the parliamentary NUJ group. The situation has slightly changed since I requested the debate, which is basically about job cuts in regional and provincial newspapers. The Daily Mail and General Trust's proposal to sell off Northcliffe Press, which has 113 titles, including the Grimsby Telegraph and the Scunthorpe Telegraph, has now been postponed pro tem.
	I wonder whether that is because I wrote to Lord Rothermere personally to advise him against the move. Although I do not like Northcliffe's politics in any way, it is one of the better organised groups and it has always been more concerned with quality, journalistic standards, training and the appointment of good editors—certainly at the Grimsby Telegraph—within the group. Grimsby has always had a good quality local evening paper, so I did not want the young Lord Rothermere to be misled by City slickers advising, as they usually do because of the fees that they get, "Sell and acquire," or by the conmen who often cluster round powerful figures advising them to invest in new technology such as the dotcom bubble of a few years back and abandon what they are doing well. I was delighted that although Lord Rothermere's reply did not exactly say, "My God, Mitchell, you are quite right. Why didn't I think of that? Would you like a directorship?", the plans have been slightly postponed, and I hope that that will give us the power to fight another day in this matter.
	As an illustration of what is going on in the local press because of the preparations for the sale, Northcliffe's strategy involved a programme of redundancies and job losses. As the term goes, there was a "feeding down" of local newspapers to make them more profitable before selling them. The programme was called "Aim Higher", which journalists, with their usual cynicism, promptly called "Aim Fire". That involved getting rid of substantial numbers of journalists throughout the country to make the group more saleable.
	That process has been repeated in every newspaper group throughout the country. These days, provincial newspapers are basically in chains. They are born free, but everywhere they are in chains, and the chains are looking to profitability. Trinity Mirror has 230 titles. Last year, it made a profit of £172 million. It is proposing hundreds of redundancies. Newsquest was £700 million in profit last year. It has 216 titles. It has already fired 25 subs in Colchester and between 60 and 70 in Scotland. Johnston had a profit of £177 million last year. It has 283 titles. It has just closed its press in Scarborough. Archant made a profit of £332 million out of 80 titles and is firing 17 subs in Norfolk. Even The Guardian is going through this process. There will be hundreds, if not more than 1,000, job losses in provincial newspapers.
	This is being done at a time when the provincial press is profitable. It is said that it is being done because other advertising media—internet websites—will take revenue from other forms of profitable classified advertising, which provides about 50 per cent. of the revenue of local newspapers. If that were the motive, newspapers could always buy up the competition, as they bought up the free sheets. At present, regional newspapers are very profitable and becoming more profitable year on year. Profit margins are between 20, 25 and 35 per cent. Those margins are higher than any margins in the local press in France, Germany, Europe generally and in the United States. Advertising spending is increasing in local newspapers by 5.8 per cent. a year, and has increased every year for 13 years.
	It is not the fact that these newspapers are unprofitable and are thus subject to job losses. They are local monopolies that do not face competition, which would enforce higher spending, so they are able to reduce the numbers of journalists and to cut spending on staff generally. The other factor to take into account is the growing power of the newspaper chains that want to increase the rate of return that they pay to their shareholders. In fact, that is the main explanation for what is going on.
	The consequences of those job losses fall on the quality of the newspapers. Despite what some directors and, particularly, accountants seem to think, journalists do need newspapers, and newspapers need journalists. Newspapers cannot be produced without journalists. Cut the journalism and all else fails. That is a failure from which we all suffer, as does local democracy. There is less coverage of council meetings, less coverage of the courts and less coverage of all local bodies. There is less coverage of the arguments over, for example, academy schools. There is less discussion and less analysis of what is going on locally.

David Taylor: The Leicester Mercury is a Northcliffe newspaper, and an excellent newspaper. One of the subjects that my hon. Friend has described is creeping out of its coverage—local issues at sub-county level are getting much less coverage, not least because such newspapers are in slow-managed circulation decline. Therefore, advertising is providing a higher proportion of income.